How the Choose and Book system will work in your practice

In many ways the merging of PCOs would be welcome (January 29). The re-creation of district health authorities (DHAs) in their final form, which integrated both primary and secondary care and promoted very effective commissioning, would be a considerable improvement on the present fragmented and inefficient system.

Unfortunately, now that much of the expertise contained in the old DHAs has been dissipated and lost, one has to wonder if they will be fit for purpose.

The whole exercise of PCGs-PCOs has been a predictable disaster for integrated health care which was just beginning to settle down after the amalgamation of DHAs and FHSAs. It is the unfortunate hallmark of this administration that they impose changes before the evidence for change has been adequately analysed and this is yet another example of the adverse consequences of this misguided policy.